Anesthesia cart

ABSTRACT

A computerized medication dispensing station that addresses anesthesia medication management and tracking problems is disclosed. Medications, including narcotic and non-narcotic, and supplies for use in anesthesia, are stored in secured, semi-secured, and unsecured containers of a mobile station. A computer housed in the station is used to track the anesthesiology items that have been removed from the station. For each item removed, the time of removal, who removed it, and to whom it was administered is tracked. Items that are not administered to a patient are returned to the pharmacy or wasted (i.e., disposed in accordance with regulations). Each type of event (administration to a patient, return, or waste) is documented so that a health care institution can track usage of items, including narcotic medications, for use in anesthesia.

BACKGROUND OF THE INVENTION

[0001] 1. Field of the Invention

[0002] The present invention relates generally to computerizedmedication management and dispensing stations. More particularly, thepresent invention relates to a system, method, and apparatus forcontrolling the dispensing and inventory of anesthesiology items in ahealth care institution.

[0003] 2. Description of Related Art

[0004] Medication management in anesthesia presents a challenge for boththe pharmacy and the anesthesia departments in health care institutions.Anesthesia requires open, unrestricted access to many medications,including narcotics as well as supplies. Pharmacies, on the other hand,must control access to medications and impose security measures.Organizations such as the Joint Commission on Accreditation ofHealthcare Organizations (JCAHO), the Drug Enforcement Agency, and theState Boards of Pharmacy require strict documentation and record keepingof narcotic usage. The JCAHO provides accreditation to member hospitals.In order to earn and keep the JCAHO accreditation, hospitals must adhereto strict access and control policies for medications or risk potentialfines and possible shut down of the facility. Fines related to impropermanagement of narcotics in one operating room can be $15,000.00 or moreper offense. A study found that 11% of all hospitals reviewed by theJCAHO received a recommendation for improvement based on improperhandling of narcotics.

[0005] The pharmacy is responsible for medications, particularly from aregulatory perspective, but is able to manage the medications onlyremotely. As a consequence, a serious responsibility gap exists inmedication control from the time the medications are issued toanesthesiologists until the end of the day when remaining medicationsare returned. Complying with federal regulations is often a tedioustask. Anesthesia records are often incomplete with respect to accuratemedication usage documentation during and after a procedure. Currentmethods of anesthesia narcotic medication management are labor intensivefor pharmacists and anesthesiologists, often leading to costly errors.Currently, narcotics are generally tracked in one of two fashions.

[0006] A first method of tracking narcotics, the satellite pharmacy, isused at some of the larger hospitals. Affluent hospitals often provide asatellite pharmacy that services the special needs of the operatingroom. The anesthesiologist signs out narcotics from the satellitepharmacy by going to the pharmacy and interacting with a pharmacist. Ifa pharmacist is not available, one must be paged. The anesthesiologistreturns to the satellite pharmacy when a free moment is found toreconcile the unused medications with a pharmacist. Reconciling unusedmedications requires documenting on the patient record or returning tothe pharmacy all medications that were signed out by theanesthesiologist. The pharmacy disposes of contaminated medications(referred to as “waste”) or returns unused medications to stock. Thisprocess is time-consuming and cumbersome to both the pharmacy and theanesthesiologist. The task requires a pharmacist to be available at alltimes that the operating room is in operation. Anesthesiologists musttake time away from patient care to reconcile medication usage with thepharmacy. To mitigate these constraints, anesthesia and nursing staffhave unsupervised access to the satellite pharmacy during off hours. Theburden of narcotic tracking, however, still falls on the pharmacy duringthese off hour periods and the healthcare facility is exposed topotentially severe regulatory agency repercussions.

[0007] Satellite pharmacies are becoming rare due to the expense andoverhead of running a specialized pharmacy. As an alternative, manyhospitals are using a second method of tracking narcotics called thetackle-box method. The tackle box is a small, locked container that isprepared by the main pharmacy for each anesthesiologist. Theanesthesiologist picks up his or her tackle box in the morning from themain pharmacy or from a locked room in the operating room. The locationusually depends upon the pharmacy's delivery capabilities. The tacklebox usually contains a usage sheet where the anesthesiologist recordsthe medications that were used, the patients on which the medicationswere used, and the quantities dispensed. The completed sheet and unusedmedications are returned at the end of the day to the main pharmacy orto the locked room. The pharmacy must inspect each medication record toinsure accuracy and compliance. Any inconsistencies must be addressedwith the anesthesiologist. However, the inconsistencies may not beaddressed for several days at which point the anesthesiologist may notremember the exact circumstances surrounding the medication discrepancy.The hospital is in direct violation of the regulations until thediscrepancy is resolved.

[0008] Attempts to automate the medication management process inanesthesia have been made. One product that is currently available is asemi-automated tackle-box system of narcotic medication control made bySecure-1, Inc. of Hamilton, Ohio. A small (about the size of a loaf ofbread) metal box with a LCD screen and keypad on its face is used toperform narcotic medication control. The anesthesiologist signs out abox from a storage location. After the box has been removed from thestorage location, only the anesthesiologist who signed out the box mayopen it. Once open, all the medications, including narcotics, arereadily accessible. Documentation is provided via the small LCD screenand keypad. Dosages are recorded in the system by time and patient.Although the system provides some electronic information capture, thereis still much legwork to be done. First, the anesthesiologist must gosomeplace to sign out the box. Because of the small size, only narcoticsmay be stored in the box. The anesthesiologist must gather the requirednon-narcotics via the old methods described above—either through asatellite pharmacy or a medication cabinet located somewhere outside theoperating room. When a case is over, the anesthesiologist must returnthe box to its storage location where the pharmacy retrieves it toverify and refill contents usage. This product still requires a greatdeal of manual labor to complete the tracking process. Theanesthesiologist is required to carry the box throughout the day. Inaddition, the anesthesiologist must personally remove the box from astorage location (e.g., outside the operating room) and return it to thesame storage area at the end of the day.

[0009] The above two scenarios form the basis for medication managementin the operating room today. Each requires both time and people tocomplete the tracking process. Even in a perfect environment, mistakesare made, medications are not documented, documentation is not accurate,or items are diverted without a record. Often, the mistakes are due touncontrollable events that occur during a procedure. In some cases, ananesthesiologist may require additional medications not anticipatedprior to a case. A circulating nurse must then leave the procedure roomto retrieve the needed item. This requirement adds unnecessary andcostly delays to the procedure. Whatever the case, the result isinaccurate medication usage documentation.

[0010] In addition to control of narcotic medications, management ofnon-narcotic medications and supplies is often inefficient and leads tocostly errors. To manage non-narcotic medications and supplies,anesthesiologists typically use a system separate from narcoticmanagement. Anesthesiologists employ a non-secured, non-automated mobiledrawer cart, often a Blue Bell Cart or a Sears Craftsman tool chest, tostore these non-secured items. Narcotics are not stored in these cartsbecause the cart is not locked. Therefore, a separate system fornarcotic management is still required. Typically, every operating roomhas its own cart so that non-narcotics and supplies are readilyavailable for use by any anesthesiologist using the room.

[0011] This non-automated, non-secured practice often results in errorsin patient billing and stock-outs (i.e., depletion of the entireinventory of a particular item). Stock-out risks cause anesthesiologiststo overstock all medications and supplies in the carts, thus incurring amuch greater storage cost than necessary. If an operating room hasanesthesia technicians on staff, then the responsibility of refillingthe carts falls to them. However, due to cost cutting measures, fewfacilities have the luxury of anesthesia technicians. The responsibilityof restocking the carts then falls to operating room technicians forsupplies and the pharmacy or nursing for non-narcotics, further addingto their non-patient care oriented responsibilities.

[0012] Another factor that makes tracking difficult is the manner inwhich an anesthesiologist works. An anesthesiologist's workflow is verydifferent from that of a nurse working on a general care floor of thehospital. Typically, an anesthesiologist collects all needed medicationsbefore a case begins. The medications are prepared by a pharmacy orsatellite pharmacy and provided in a tackle box. Alternatively, thedoctor may retrieve narcotics from a locked cabinet. In either case, theanesthesiologist must take a significant amount of time to prepare for acase. In many cases, the anesthesiologist requires additionalmedications or additional quantities of a medication that were notanticipated before the case began. To address these problems, theanesthesiologist sends the circulating nurse out of the procedure roomto gather the required medication. This time-consuming process delaysthe procedure.

[0013] Another factor that makes the tracking problem complex is thatsome medications may not be used during a procedure. Unlike in a generalcare unit, when medications are signed out by an anesthesiologist, theyare not necessarily going to be administered. An anesthesiologist workswithin a given set of medications and uses those that he or she deemsnecessary for the given conditions of the patient. The medications thatare not used during the procedure must be returned to pharmacy ordisposed of (i.e., “wasting”).

[0014] Another complicating factor in the tracking process is that thepractice of anesthesia uses a small number of medications. Most of themare non-controlled. The types of medications remain relatively constantfor each type of case. Pharmacies typically provide anesthesia drugpacks or kits for certain cases such as cardiac, neuro, critical care,pediatric, and general to address these medication and supply problems.Anesthesiologists are accustomed to working with such kits and expectsuch kits to be readily available.

SUMMARY OF THE INVENTION

[0015] The present invention—the Anesthesia Cart—is a computerizedmedication and supply dispensing station that addresses anesthesiamedication management and tracking problems. The Anesthesia Cart is amobile cart that securely stores all narcotic medications, non-narcoticmedications, and supplies (collectively, anesthesiology items or items)for anesthesiologists in one complete system. Items may be stored insecured drawers that remain locked at all times and require the input ofspecific information each time they are accessed (e.g., for storingnarcotics), semi-secured drawers that remain locked until a user logs into the system (e.g., for certain types of non-narcotics and supplies),and unsecured drawers that are always unlocked (e.g., for non-narcoticsand supplies). The unit may be placed in each operating room of ahealthcare facility and replaces current anesthesia storage cabinets. Italso adds several valuable features such as tracking features. Thesystem automates patient usage records, documents waste, managesinventory levels, and tracks the anesthesiology items that have beenremoved from the station, the time of removal, who removed them, and towhom they were administered. The tracking features include informationregarding practitioner, patient, procedure, and medication or supplyitem. An automated account of medication usage may be created thatreports on effectiveness during a case as well as comparisons betweenpractices of the different doctors on staff. The reports may be based onprocedure type, practitioner, patient, or any other piece of datacaptured by the system.

[0016] Many of the problems with current tracking methods are addressed.Operation of the present invention is extremely intuitive and isconducive to the anesthesiologist's workflow. Medication or supply usageis recorded at the time the anesthesiologist confirms an administrationof an item rather than at the time of removal from the station. Theinvention stores kits containing multiple items, individual line items,or a mixture of both so that the anesthesiologist may administer themedications or use the supplies that are appropriate for the givenconditions of the patient. Additional functions for set up, loading,refilling, unloading, and performing inventory operations are alsosupported.

[0017] The present invention is a cabinet supported by wheels, casters,or rollers for mobility. The cabinet is equipped with a control unitcomprising a computer, a monitor (preferably, an illuminatedtouchscreen), and a keyboard to provide access to the medications andsupplies that are stored in the drawers of the cabinet. Ananesthesiologist interacts with the control unit via the touchscreenmonitor and/or keyboard to enter and review patient and caseinformation, to access the medications and supplies stored in thecabinet drawers, and to reconcile item usage (e.g., record theassignment, return, waste, or transfer of medications or supplies).

[0018] To use the present invention, an anesthesiologist logs into thestation's computer, removes one or more anesthesiology items, and afteradministration of the anesthesiology items, documents item usage.Documenting item usage includes assigning items to a case, returningitems, wasting items, and transferring items. Alternatively, theanesthesiologist may log into the stations' computer and select a caseso that anesthesiology items are assigned to the selected case as theyare removed. The control unit of the station is adapted to capture caseinformation as well as information regarding the anesthesiologist(s)associated with the case. Case information includes information aboutthe anesthesiology items used for a specific procedure associated with apatient including the medications that will be or have been administeredto the patient. Case information may be entered either before or afterremoval of items from the cart. It is important to note, therefore, thatthe anesthesiologist is not required to select a case prior to removinganesthesiology items from the cart. This flexibility in determining whenanesthesiology items may be documented (i.e., after items have beenremoved or as items are being removed) is unique to the presentinvention.

[0019] When the anesthesiologist is ready to administer the medicationsor supplies to the patient, he or she selects an item to be removed froma list of medications or supplies appearing on the screen. If the itemis in a secured drawer (e.g., a narcotic), it is made available forremoval. Each removal of an item from the cabinet, whether from asecured or unsecured drawer, is associated with the anesthesiologist whohas logged in to the station's computer. If the anesthesiologist hasselected a case, the items are also assigned to the selected case asthey are removed. For items removed from secured drawers, the systemprompts for information based on the medications removed, acting as areminder to the anesthesiologist to insure proper documentation. Thisdocumentation process may be done for any previously removed item at anytime during the procedure or at a later time. Following completion ofthe documentation process, the captured data provides the pharmacy withan electronic record of each medication's usage during a case. If ananesthesiologist fails to document usage, the pharmacy may then checkwith the anesthesiologist to determine why the anesthesiology item usehas not been reconciled.

[0020] The present invention provides significant advantages over theprior art. First, the station is mobile and may hold all medicationsrequired for a procedure in the room. An anesthesiologist may locatemedications and supplies quickly and easily as they are needed. Usingthe present invention, the anesthesiologist no longer needs to stand inline at a satellite pharmacy or carry around keys to a narcotic room oruse simultaneous processes to obtain needed supplies. Second, thedocumentation process is facilitated with the real-time, interactivesystem of the station. The necessary information is collected andprocessed as anesthesiologists assign items to cases. Third, thereporting capabilities provide the pharmacy and administration withaccurate drug practice information. Health care institutions that usethe present invention feel secure that required items will beimmediately available and that medication and supply usage documentationwill be completed properly. The present invention saves hours ofunproductive legwork and manual documentation that are required by priorart systems.

BRIEF DESCRIPTION OF THE DRAWING(S)

[0021]FIG. 1 is an example of an anesthesia cart in accordance with thepresent invention;

[0022]FIG. 2 is an example of a molded handle for an anesthesia cart inaccordance with the present invention;

[0023]FIG. 3 is an example of a cabinet cover and computer componentsfor an anesthesia cart in accordance with the present invention;

[0024]FIGS. 4A and 4B are examples of a monitor and keyboard for acomputer housed in an anesthesia cart in accordance with the presentinvention;

[0025]FIG. 5 is a flowchart of the process for interacting with theanesthesia cart of the present invention;

[0026]FIG. 6 is an example of a login screen for a preferred embodimentof the present invention;

[0027]FIG. 7 is an example of a main menu screen for a preferredembodiment of the present invention;

[0028]FIG. 8 is an example of a item list screen for a preferredembodiment of the present invention;

[0029]FIG. 9 is an example of a take screen for a preferred embodimentof the present invention;

[0030]FIG. 10 is an example of a cases screen for a preferred embodimentof the present invention;

[0031]FIG. 11 is an example of a case summary screen for a preferredembodiment of the present invention;

[0032]FIG. 12 is an example of a removed item list screen for apreferred embodiment of the present invention;

[0033]FIG. 13 is an example of a reconcile screen for a preferredembodiment of the present invention;

[0034]FIG. 14 is an example of a detailed functional organization chartfor a preferred embodiment of the present invention; and

[0035]FIG. 15 is a flowchart for the overall operation of the anesthesiacart for a preferred embodiment of the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT(S)

[0036] Referring to FIG. 1, the anesthesia cart 100 of the presentinvention, preferably, is a compact cabinet 102 supported by wheels 104so that it may be moved easily throughout an operating room.Alternatively, casters or rollers may be used to increasemaneuverability of the cart. A handle 106 molded with the top surfacefacilitates movement of the cart in all directions. A bumper 108 aroundthe bottom periphery of the unitop surface protects the cart from beingdamaged in the event of a collision. Finally, a flat work surface area110 and pull-out shelf 112 provides ample space for performing a varietyof tasks in addition to dispensing and controlling anesthesiology items.

[0037] As used herein, “anesthesiology items” refers to all narcoticmedications, non-narcotic medications, and supplies such as Fentanyl,Pentothal Sodium, Demerol, Prostigmin, Robinul, syringes, needles,catheters, masks, etc. Anesthesiology items to be dispensed are storedin drawers or receptacles 114, 116 of a variety of shapes and sizes.Drawers may be secured 114, semi-secured 116, or unsecured depending ontheir contents. Each drawer may have associated with it a controlmechanism comprised of hardware (e.g., solenoids and additionalcircuitry for accepting authorization signals from software components)and/or software components (e.g., user and password requirements forcommunicating authorization signals to drawer hardware). Secured drawersremain locked until a user requests an item (usually a narcoticmedication) and follows a procedure for accessing the contents of adrawer. Preferably, only the drawer containing the requested item istemporarily unlocked for access. Upon closing, the drawer is re-secured(i.e., locked) so that the user is required to input information to openthe drawer and access its contents a second time. For example, in oneembodiment of the present invention, secured drawers may be partitionedinto consecutively spaced compartments and controlled by a solenoid andother hardware to allow graduated access to the compartments. Previousactivity of the drawer is tracked so that when later accessed, thedrawer may pop open or may be allowed to be pulled open to a length thatexposes the contents of a compartment either not emptied or uncovered inprevious openings. Drawers in accordance with the present invention maybe fashioned as described in U.S. Pat. No. 5,716,114, entitledJerk-Resistant Drawer Operating System, issued to the applicant of thepresent invention on Feb. 10, 1998 which is hereby incorporated byreference herein.

[0038] Another type of drawer that may be employed in the anesthesiacart is the semi-secured drawer. A semi-secured drawer may be coupledwith a control mechanism that allows the entire drawer to be opened uponinput of required information (e.g., logging on to a station computer).The drawer remains unlocked and may be opened and closed repeatedlyuntil an event causing the drawer to be secured occurs (e.g., loggingoff of a station computer).

[0039] In an alternative embodiment of the present invention, theanesthesia cart may be equipped with latched receptacles in which eachreceptacle has a computer controlled latch and associated hardware thatprovides information about the contents of the receptacle to a computer.The latch may be opened and the contents of the receptacle accessed uponentry of required information at which time an authorization signal isreceived at the latch. Latched receptacles may be configured to requiredentry of required information upon each access or to be unlatched uponthe occurrence of a first event (e.g., login to a station computer) andlatched upon the occurrence of a second event (e.g., logout of a stationcomputer). In this respect, the latched receptacles may be configured tooperate in a fashion similar to that of the secured and semi-secureddrawers. Latched receptacles in accordance with the present inventionmay be fashioned as described in U.S. patent application Ser. No.09/987,388, entitled System and Apparatus for the Dispensing of Drugs,assigned to the applicant of the present invention and filed on May 29,1998, which is hereby incorporated by reference herein.

[0040] In a preferred embodiment of the present invention, narcoticmedications are stored in secured drawers 116 such that theanesthesiologist is required to follow specific procedures to reachtheir contents. Preferably, the anesthesiologist is required to requesta specific amount of a secured medication before the drawer containingit is opened. The anesthesiologist accesses the specific amount of thesecured medication that was requested. Non-narcotic medications andsupplies may be stored in semi-secured drawers 116 so that theanesthesiologist may access them after login. Preferably, thesemi-secured drawers unlatch and latch simultaneously upon user loginand log-out, respectively, so their contents are freely available duringa procedure. Finally, non-narcotic medications and supplies may bestored in unsecured drawers so they are accessible to anyone at anytime. It is understood that the anesthesia cart may be configured withany combination and size of secured, semi-secured, and unsecured drawersand/or latched receptacles depending on the needs of the users. In otherwords, the anesthesia cart of the present invention may be configuredwith a plurality containers (e.g., drawers and/or latched receptacles)any of which may be secured, semi-secured, or unsecured. In addition, itis understood that anesthesiology items may be stored in any type ofcontainer (e.g., drawer and/or receptacle) depending on the needs of theusers.

[0041] An access control unit comprising a computer, monitor 118, andkeyboard 120 (or equivalent type of data entry device and/or dataprocessor) equipped with appropriate user interface, communications,etc. software provides access to the anesthesiology items that arestored in the containers of the cart. A container control unitcomprising additional hardware (e.g., switches, sensors, solenoids,pulleys, stops, cables, motors, drums, etc.), circuitry, and logicprovides communication between the software of the access control unitand container hardware including any latch that may be used for securingthe container. Each container may have its own control unit. Softwareand hardware for the control of containers (e.g., drawers and/or latchedreceptacles) in accordance with the present invention may be fashionedas described in U.S. Pat. No. 5,445,294, entitled Method for AutomaticDispensing of Articles Stored in a Cabinet, assigned to the applicant ofthe present invention and issued on Aug. 29, 1995. Consequently, thecontainers of the present invention may be controlled by a computer orits equivalent (e.g., data entry device and/or data processor).

[0042] Each drawer may be further subdivided into two or morecompartments each of which may hold the various medications or suppliesto be administered to patients. The computer and other components thatan anesthesiologist need not access while using the cart may be housedinside the cart. Preferably, housed components are accessible through acover 122 on the side of the cart. A rotating extension monitor stand124 makes it easy to view the monitor 118 from a variety of angles.Preferably, the monitor 118 is a color touchscreen for easy data entry.Lists of patients, anesthesiology items, etc. may be presented andselected by touching the desired list item. The attached keyboard 120may also be used for data entry. Other types of data entry devicesand/or data processors may be used as well.

[0043] Preferably, the cart is equipped with a floppy disk drive 126 forloading information onto the station computer and performing maintenancefunctions, etc. Preferably, the floppy disk drive is accessible only toauthorized personnel such as maintenance technicians. The cart may alsobe equipped with a CD-ROM 128 that may be used to access referencemanuals and other information that may assist the anesthesiologist inperforming his or her duties. Preferably, the cart is equipped with anetwork card and other devices that support networked communicationssuch as those that may be required to interact with the pharmacycomputer systems and other departmental computers. Although equippedwith a network card, the cart computer need not be connected to acomputer network to operate. The network card allows the cart computerto be connected to another computer system to facilitate the exchange ofinformation between the cart computer and another computer system (e.g.,for inventory control, for maintenance, for transferring statusinformation). Finally, the cart may be equipped with accessory holders128, 130 that allow the anesthesiologist to transport items that may berequired such as gloves, tape dispensers, container for waste, clockwith timer, file folders, vial holders and an IV pole.

[0044] Referring to FIG. 2, a unitop 200 for a preferred embodiment ofthe anesthesia cart is shown. As explained above, the handles 106 and110 are a one piece unit. A bumper 108 around the periphery providesprotection of the station and its contents.

[0045] Referring to FIG. 3, a cabinet cover 122 and computer componentsfor an anesthesia cart in accordance with the present invention isshown. The cover 122 protects the computer housed in the station as wellas provides easy access to the various components that comprise thecomputer. First, a mother board 302 may be mounted inside the station.In addition, the station may be equipped with an electronic display sled310 and a wire harness routing hold 308. Other computer componentsinclude a floppy disk drive 126 and a CD-ROM drive 128.

[0046] Referring to FIG. 4A, a monitor 118 and keyboard 120 (orequivalent data entry video terminal) for a computer housed in ananesthesia cart in accordance with the present invention is shown. Asexplained above, the monitor 118 and keyboard 120 are preferably mountedon a rotating stand 124 for easy access. The rotating stand 124preferably, is equipped with several pivot points 408 and 410 for easystorage of the monitor and keyboard and transportation of the unit. Themonitor 118 and keyboard 120 may also be connected by a pivot point 406.The incorporation of pivot points 406, 408, 410 allow the monitor 118and keyboard 120 to be closed in a configuration similar to a laptopcomputer and folded on to the work surface as shown in FIG. 4B. In theclosed configuration, the monitor and keyboard may be protected duringtransportation of the station. Other types of data entry video terminalsmay be used as well.

[0047] A set up function in the software provided with the cart computerallows a user with appropriate privileges to perform generaladministrative tasks as well as to set station and containerconfigurations and create kits. Load, refill, unload, and inventoryfunctions that are supported in the software provide assistance instocking the cart with appropriate anesthesiology items. Medications tobe administered from the containers of the cart may be stored asindividual items, logical kits, or physical kits. A logical kit (orpersonal kit) is a logical grouping of medications and/or supplies andmay be personalized for each anesthesiologist. The logical kit maycontain logical groupings of anesthesiology items for a specificprocedure (e.g., neuro, cardiac, etc.) The logical or personal kitprovides a shorthand method for selecting multiple items in specificquantities. Each item in a logical or personal kit is an individualinventory item stored in its own location (e.g., its own compartment inthe cart). A physical kit, on the other hand, contains multipleanesthesiology items of the same type. For physical kits, individualcomponents may be pre-packaged in the pharmacy and stored in a singlecompartment in the cart. In this case, the items are removed from asingle compartment. When either type of kit is removed from the cart,the kit is expanded into its component items which are then associatedwith the anesthesiologist and may be managed individually. Transactiondocumentation may be completed for each individual item contained in thekit.

[0048] Preferably, the cart system of the present invention supports twounits of measure—vending units and administration units. Vending unitsrelate to the manner in which medications are packaged (e.g., one vialcontaining 10 ml of a medication). Functions related to cart inventory(e.g., loading, unloading, and refilling) use vending units.Administration units relate to the manner in which items are used on apatient regardless of how they may have been packaged (e.g., 10 ml ofAmidate may be administered, not one vial). Conversion between vendingand administration units is accomplished through the integer ratio ofadministration units to vend units for each item.

[0049] Referring to FIG. 5, the process for use of the anesthesia cartby an anesthesiologist is shown. First, in step 500, theanesthesiologist logs into the station. An example of a login screen fora preferred embodiment of the present invention is shown in FIG. 6. Thelogin procedure may be based on a standard identifier and passwordscheme. Alternatively or in conjunction with the primary loginprocedure, the login procedure may be based on biometrics such aseyeprint, fingerprint, etc. Upon login, the anesthesiologist ispresented with a main menu presenting options for proceeding. An exampleof a main menu for a preferred embodiment of the present invention isshown in FIG. 7. As shown in FIG. 7, the three options of greatestinterest to the anesthesiologist are the “Take,” “My Items,” and“Cases.” The “Setup,” “Load,” “Refill,” “Inventory,” and “Unload”functions may be used by personnel responsible for stocking the cart andperforming other administrative functions necessary for maintenance ofthe cart. As shown in step 502 of the flowchart of FIG. 5, the primaryfunctional options of the main menu are presented to theanesthesiologist (i.e., “Cases,” “My Items,” and “Take”). By selecting“Cases,” the anesthesiologist may perform actions related to definitionof patient cases (step 504). A case is a specific procedure (e.g.,cardiac, neuro, orthopedic, etc.) that is associated with a specificpatient. By selecting “My Items,” the anesthesiologist may performactions related to documentation of items removed from the cart (step518). By selecting “Take,” the anesthesiologist may perform actionsrelated to removal of items from the cart (step 516). Once the doctorsigns in (step 500), a permanent anchor is set until he or she logs out.Preferably, the system does not automatically log out theanesthesiologist. Instead, the anesthesiologist may choose when tologoff the system. This procedure prevents untimely time-outs that mayserve only to frustrate the anesthesiologist. Preferably, at this point,semi-secured containers may be unlatched so that their contents may beaccessed. The anesthesiologist may lock the cart to prevent unauthorizedaccess if he or she needs to leave the cart's locale for any reason.Locking a cart prevents access to the cart by anyone except theauthorized anesthesiologist(s) or a system administrator. If anadministrator logs on, any outstanding items are recorded as notaccounted for by the doctor who removed them.

[0050] In step 516, the anesthesiologist may begin the process ofremoving items from the cart (Take). To take an item, theanesthesiologist indicates that he or she has removed an item from thecart. The removed item is automatically associated with the identifierprovided by the anesthesiologist during the login procedure. The removeditem is not, however, assigned to a case unless the anesthesiologist hasalready selected a case. In this case, the item is “take case specific”and is automatically assigned to the selected case. An example of a takelist for a preferred embodiment of the present invention is shown inFIG. 8. As shown in FIG. 8, the anesthesiologist is presented with theoptions of selecting secured items, unsecured items, or supplies.Preferably, items are removed in vend units which may or may notcorrespond to administration units. For example, one 10 ml of vial ofAmidate may be removed resulting in 10 ml of medication that may beadministered individually. Therefore, the removal of one vial may beshown as 10 ml. A window showing selected items and quantities of itemsmay be presented to the anesthesiologist (e.g., by selecting a “Picks”button). Preferably, the quantity of an item may be changed by repeatedtouches or by using a numeric input field and increment/decrementbuttons. If a kit is selected, the component line items that comprisethe kit may be viewed by selecting, for example, a “Contents” button.

[0051] As explained above, the contents of semi-secured containers maybe accessed following the login procedure. The anesthesiologist may thenopen the semi-secured containers and remove items as needed. Preferably,the anesthesiologist is not required to request items from semi-securedcontainers using the software interface. If a kit is selected,preferably, the anesthesiologist may view the component items byselecting a Contents button. When convenient, the anesthesiologist mayinform the system of which items have been removed from semi-securedcontainers by selecting them from a list of semi-secured items that mayinclude non-narcotic medications or supplies. For secured medications(i.e., narcotics), the anesthesiologist, preferably, is required torequest a specific amount of medication before the container containingit opens. An example of a screen for requesting a secured medication fora preferred embodiment of the present invention is shown in FIG. 9. Uponselection of a Take button, access to the secured container may bepermitted. Referring again to FIG. 5, as secured items are removed fromthe cart, they are added to a table of removed items to be reconciled ordocumented as shown in step 518. The removed items are associated withthe identifier provided by the anesthesiologist at login. The removal ofsemi-secured and unsecured items is recorded (i.e., associated with theidentifier) without further interaction from the anesthesiologist.Additional item removal may be done at any time during a procedure.

[0052] Following completion of the item removal, the anesthesiologist ispresented with one of two screens. If the take operation was initiatedfrom the main menu or the My Items option, the anesthesiologist ispresented with the list of medications that have been removed (step518). If the take operation was initiated from a case summary, theanesthesiologist returns to the case summary page (step 512). Theanesthesiologist therefore, may begin the process of removing itemsusing one of two methods and may choose the one he or she finds mostconvenient.

[0053] Step 504 is the entry point for case management functions. Atstep 504, a list of all cases that have been entered into the system ispresented to the anesthesiologist. An example of a case list for apreferred embodiment of the present invention is shown in FIG. 10.Referring again to FIG. 5, at step 504, the anesthesiologist has theoption of performing tasks related to an existing case by selecting acase from the case list (step 512) or entering a new case (step 506). Toenter a new case (step 506), the anesthesiologist preferably selects apatient name from a list of admitted patients. To further facilitate theprocedure of selecting a patient name, an interface to an operating roomscheduling system may be provided so that the anesthesiologist may seewhich patients are scheduled for surgery. Alternatively, theanesthesiologist may enter a patient name or other patient identifier tolocate a patient. If a patient cannot be found in the system, theanesthesiologist may enter new patient data. Once a patient has beenselected, the anesthesiologist may enter additional patient dataincluding a case type, a case number, a CPT code, general notes andother data relevant to the patient's condition, etc. (Step 508). In thenext step related to a new case (step 510), the anesthesiologist enterscase data for the selected patient. The case data is then saved and maybe available in a case summary.

[0054] In the next step (step 512), the anesthesiologist may review asummary of the case before assigning items to the case. An example of acase summary screen for a preferred embodiment of the present inventionis shown in FIG. 11. Referring again to FIG. 5, if case information hadbeen entered previously, the anesthesiologist may select a case (step504) and then, review a summary for the selected case (step 512).Otherwise, the anesthesiologist may proceed to the case summary function(step 512) after entering the case data (step 510). The case summarydisplays a list of all items that have been assigned to a specific case.Items preferably, are displayed in quantities of administration units(e.g., 10 ml rather than 1 vial).

[0055] In step 514, the anesthesiologist assigns items (i.e.,medications or supplies or kits) to the selected case. In the assigningitems, individual items that have been taken from the cart areassociated with the selected case. Individual items and dosages may beselected from predefined lists or they may be entered through a dialogbox or other screen appearing on the monitor. The anesthesiologist maychange the quantity of a medication administered to a patient. Forexample, if the case indicated that 10 ml of a medication would beadministered, but only 5 ml was actually administered, theanesthesiologist may indicate that a smaller quantity was actuallygiven. The balance not recorded as administered may be wasted, returned,or may remain in the possession of the anesthesiologist foradministration to a different patient. Alternatively, theanesthesiologist may assign a kit to the case. As items and/or kits areassigned, a medication list is compiled to indicate which items or kitsare in the cart. Preferably, in all operations in which lists ofmedications or supplies are displayed, the anesthesiologist has theoption of reviewing items in brand name descriptions or generic namedescriptions. Preferably, brand/generic name display modes may becontrolled by a toggle button at the bottom of a list.

[0056] In step 518, the reconciliation or documentation procedure isperformed. As shown in FIG. 5, the anesthesiologist may reach thisfunction by selecting “My Items” or “Take” from the main menu 502 orfrom a Case Summary 512. To reconcile usage, the anesthesiologist beginsby reviewing a list of items that are in his or her possession (i.e.,that have been associated with his or her identifier) that have beenremoved from the cart, but have not been assigned to a case, returned tothe pharmacy, wasted, or transferred to another anesthesiologist. Anexample of a “My Items” list for a preferred embodiment of the presentinvention is shown in FIG. 12. Quantities of each item are also shown.From the earlier example, a 10 ml vial of Amidate may be represented onthe screen as 10 ml rather than one vial of Amidate. From this list, theanesthesiologist informs the system as to where each dose of everymedication goes. Once an item from the list is chosen, theanesthesiologist is prompted for the dosage amount, the administrationtime (default to current time), the amount wasted, the amount returned,and/or the amount transferred. Any remaining amount is assumed to stillbe in the anesthesiologist's possession. After each medication isaccounted for, the list of removed items is redisplayed until all itemshave been accounted for. If there are no items outstanding (i.e., noitems are in the doctor's possession and still associated with his orher identifier), the anesthesiologist may logoff the system.

[0057] In step 520, items are assigned thus indicating that medicationswere actually administered to a patient. The amount of medicationactually administered to the patient is recorded. An example of a“Reconcile” screen for a preferred embodiment of the present inventionis shown in FIG. 13. Referring again to FIG. 5, first, the systemdetermines whether a case is open (step 522). If a case is open, in step512, the anesthesiologist may review the case summary and proceed tostep 514 to assign items and/or kits. The case information may bedisplayed at the bottom of the screen. If a case is not open, in step504, the anesthesiologist may review a list of cases as explained above.

[0058] In addition to assigning items to a case (i.e., indicating thatmedications were actually administered to a patient), items may bereturned to the pharmacy, wasted, or transferred to anotheranesthesiologist (step 524). For the transfer function, the acceptinganesthesiologist, preferably, is required to enter an ID and password toconfirm the transfer. Items may be returned, wasted, or transferred atany time although preferably, they are returned, wasted, or transferredafter the patient procedure is finished.

[0059] Once items have been documented (which includes assigning,returning, wasting, or transferring), they no longer appear in the listof medications removed by the anesthesiologist and are no longerconsidered to be in the possession of the anesthesiologist.Documentation, which includes assigning, returning, or wasting items,may be performed at any time on an open case. Preferably, multiple casesmay be open at a time. The documentation procedure is automaticallyactivated when the items are assigned to a case.

[0060] The process of wasting medications or supplies is a matter ofhospital and JCAHO policy. Federal regulations require a witness to bepresent when a narcotic medication is wasted. The system requires awitness identifier (e.g., name or code of a witness to the wastingtransaction) before recording a narcotic waste transaction. If allwastes are saved until the case is completed, a single witnessidentifier may be entered for all wastes that the anesthesiologistperforms. Returned medications may be made available to the pharmacy forinspection. The pharmacy may then determine whether the returnedmedication may be used. These wasted transactions may be saved at thepharmacy system and reconciled manually with the physically returned andwasted medications.

[0061] Referring to FIG. 14, a complete list of the functions of thepresent invention is shown. In addition to operating as anadministration tool, the present invention may be used for inventorycontrol. In a preferred embodiment, the present invention supports three“refill” modes. Item counts are tracked as items are removed from thecart. The system preferably informs the anesthesiologist when certainitems are at or below a reorder point, at or below a critical low level,and below the full level. The system may further be designed to accept arefill amount to be delivered which may or may not correspond to theprior “fall” level. When used for inventory control, the system mayinclude a feature in which the pharmacy or materials management isalerted regarding items in the cabinet that need to be refilled.

[0062] Referring to FIG. 15, a flowchart of the overall operation of theanesthesia cart for a preferred embodiment of the present invention isshown. As explained previously, the anesthesia cart may operate inconjunction with a pharmacy computer system so that inventory controlfunctions may be performed. To begin the process (step 600), the cart isstocked with anesthesiology items. As indicated above, theanesthesiology items may include narcotic and non-narcotic medicationsas well as supplies. In addition, individual items may be packaged andloaded into the cart as kits. All items that are required by theanesthesiologist to perform his or her job may be packaged (e.g., intokits) and loaded into the cart. In this respect, the cart contents maybe tailored or personalized for a particular anesthesiologist. Items maybe loaded into secured, semi-secured, and unsecured containers asrequired and depending upon how the cart has been configured. Stockingmay be performed by the pharmacy or any department responsible foranesthesiology items.

[0063] In the next step (step 604), the cart may be moved to an area inwhich a procedure may be performed on a patient. The anesthesiologistthen logins into the cart computer (step 606). Preferably, thesemi-secured containers are then unlocked. In the next step, theanesthesiologist then decides which item should be removed for theprocedure and selects the required item (step 608). If the selected itemis in a secured container (step 610), the anesthesiologist may beprompted for additional information to access the contents of thesecured container. In step 612, the anesthesiologist enters the requiredinformation and the secured container is unlocked. If the selected itemis not in a secured container, the anesthesiologist may simply removethe item from the semi-secured or unsecure container. In step 614, theitem is removed from the container. In step 616, the anesthesiologistadministers the medication to the patient or otherwise uses the item asappropriate for the procedure. In step 618, the anesthesiologist decideswhether additional items are necessary to complete the procedure. If theanesthesiologist is ready to start performing another procedure whilecompleting the current procedure, he or she may start the process ofremoving items for the next procedure. The anesthesiologist is notrestricted to removing items for only the current procedure. Asexplained previously, the anesthesiologist may elect to have all itemsremoved assigned to an open case, but is not required to do so. If theanesthesiologist would like to remove additional items, he or shereturns to step 608.

[0064] If the anesthesiologist has completed the procedure or hasotherwise determined that no additional items are required at thepresent time, the process of documenting usage or reconciling items maybegin (step 620). Items that have been removed from the cart, in thisstep, are assigned, returned, wasted, or transferred depending onwhether the item was used and how it was used. When the documentation orreconciliation process is completed, the cart may be connected to thepharmacy computer system (step 622) so information regarding status ofthe items in the cart may be communicated to the pharmacy computersystem (step 624). At this point, the pharmacy may determine whether allitems have been accounted for and whether narcotic medications may stillbe in the possession of the anesthesiologist. In addition to supportingthis important regulatory function, the pharmacy may also determine whatitems need to be restocked so the cart may be used again for additionalprocedures (step 626).

[0065] The present invention may be used as either an electronicmedication administration record for anesthesia or a medication andsupply accountability and inventory system. The system may be designedto accept administration information for each dosage of a medicationgiven or a summation of all medications used. The former provides anaccurate administration record while the latter provides an inventoryrecord. In a preferred embodiment of the present invention, both methodsare available as a configuration parameter. The hospital may then decidewhich method to use depending on the its needs and policies.

[0066] The present invention balances the need for anesthesiology itemmanagement with convenience and accessibility. The pharmacy's concernsregarding control are addressed as are the anesthesiologist's need foraccessibility. The Anesthesia Cart is a fully integrated system thataddresses the functional needs of anesthesiologists and closelycomplements their workflow. The Anesthesia Cart supports healthcarefacilities in their efforts to comply with medication managementregulations and reduces the potential for facilities to experiencenoncompliances. In addition, the data that may be obtained and analyzedfrom the system may be used to develop best practices for the facility.

[0067] Numerous modifications and variations in the invention areexpected to occur to those skilled in the art upon considerations of theforegoing descriptions. Although described in relation for use by ananesthesiologist, it is understood that the present invention may beuseful to surgeons and other physicians and technicians who administercertain types or categories of medications to patients. The inventionshould not be construed as limited to the preferred embodiments andmodes of preparation described herein, since these are to be regarded asillustrative rather than restrictive.

What is claimed is:
 1. An apparatus for storing, tracking, anddocumenting usage of anesthesiology items, comprising: a mobile carthaving a plurality of containers at least one of said containers adaptedto be secured for authorized access; a plurality of anesthesiology itemsadapted for use during anesthetic procedures, resident in at least oneof said containers; a data entry device on said cart, said data entrydevice adapted to enable an individual administering anestheticprocedures to enter an identifier for said individual and informationrelevant to a selected anesthesiology item and adapted to associate saididentifier with said selected anesthesiology item; a lock in associationwith said at least one secured container and in electronic communicationwith said data entry device, said lock adapted to enable said containerto be opened upon receiving said relevant information from said dataentry device.
 2. The apparatus of claim 1, wherein said containersinclude one or more of the group consisting of secured, semi-secured,and unsecured.
 3. The apparatus of claim 1, wherein said containers aredrawers and latched receptacles.
 4. The apparatus of claim 3, whereinsaid latched receptacles are housed within said drawers.
 5. Theapparatus of claim 1, wherein said data entry device includes a rotatingextension monitor stand.
 6. The apparatus of claim 5, wherein saidrotating extension monitor stand is equipped with a plurality of pivotpoints.
 7. The apparatus of claim 1, wherein said anesthesiology itemsinclude one or more of the group consisting of narcotic medications,non-narcotic medications, and supplies.
 8. A method for storing,tracking, and documenting anesthesiology items comprising the steps of:(a) storing a plurality of anesthesiology items in containers in ananesthesia cart; (b) prompting a user for an identifier; (c) providing alist of said anesthesiology items stored in said containers in saidanesthesia cart; (d) selecting for removal one of said plurality ofanesthesiology items on said list; (e) removing said selectedanesthesiology item; (f) associating said anesthesiology item with saididentifier; (g) defining a case; and (h) documenting usage of saidanesthesiology item.
 9. The method of claim 8, wherein the step ofdefining a case includes entering one or more of the group consisting ofa patient identifier, a case type, and a case number.
 10. The method ofclaim 8, wherein the step of documenting usage of said anesthesiologyitem occurs after the administration of said anesthesiology item to ananesthesia patient.
 11. The method of claim 8, wherein the step ofdocumenting usage comprises the steps of assigning a removedanesthesiology item to said case, returning at least a portion of saidremoved anesthesiology item to said anesthesia cart, or wasting saidanesthesiology item.
 12. The method of claim 11, wherein the step ofassigning said removed anesthesiology item comprises the steps ofselecting said case, entering a dosage amount, and entering a time ofadministration.
 13. The method of claim 8, further comprising the stepof assigning said anesthesiology item to said case upon removal of saidanesthesiology item from said anesthesia cart.
 14. The method of claim11, further comprising the step of transferring said removedanesthesiology item to another anesthesia cart.
 15. The method of claim8, wherein said anesthesiology items include one or more of the groupconsisting of narcotic medications, non-narcotic medications, andsupplies.
 16. The method of claim 15, wherein said narcotic medicationsare stored in secured containers in said anesthesia cart.
 17. The methodof claim 15, wherein said non-narcotic medications are stored insemi-secured or unsecured containers in said anesthesia cart.
 18. Themethod of claim 8, further comprising the step of monitoring theinventory stored in said anesthesia cart.
 19. A system for storing,tracking, and documenting anesthesiology items comprising: a cabinet forstoring anesthesiology items in containers; a container control unit incommunication with said containers for controlling access to saidanesthesiology items in said containers; an access control unit incommunication with said container control unit for determining which ofsaid anesthesiology items have been removed from said containers anddocumenting usage of said anesthesiology items removed from saidcontainers after administration of said anesthesiology items to at leastone anesthesia patient.
 20. The system of claim 19, wherein said cabinetfurther comprises secured, semi-secured, and unsecured containers. 21.The system of claim 19, wherein said anesthesiology items are stored inkits.
 22. The system of claim 21, wherein said kits are designed to becase-specific or user-specific.
 23. The system of claim 19, wherein saidaccess control unit documents usage of said anesthesiology items bystoring case information and information regarding administration,return, and wasting of said anesthesiology items.
 24. A method ofadministering anesthesia, comprising: providing a mobile cart withcontainers, said mobile cart adapted to be freely moved apart fromconnections to a computer network; stocking said containers in said cartwith anesthesiology items; providing a data processor with a data entrydevice on said cart; providing electronic communication between saiddata processor and said containers to enable said containers to beopened upon entry of predetermined data; entering data in said dataentry device relevant to a procedure involving the use of anesthetic;accessing one of said containers; removing an anesthesiology item fromsaid one of said containers; administering said anesthesiology item to apatient; and entering data regarding said anesthesiology itemadministered to said patient through said data entry device.
 25. Themethod of claim 24, further comprising: moving said cart to an areawhere anesthetic is administered to a patient.
 26. The method of claim24, further comprising: downloading said data regarding saidanesthesiology item administered, to a pharmacy computer system.
 27. Themethod of claim 24, further comprising: providing an electronic viewingterminal on said cart, said viewing terminal electronically connected tosaid data processor.
 28. The method of claim 27, further comprising:providing a computer program operable on said data processor to query ahealth care provider through a user interface visible on said viewingterminal for data regarding said anesthesiology items, said anestheticprocedure, said patient, or said health care provider.
 29. The method ofclaim 24, further comprising: providing storage compartments on saidcart.
 30. The method of claim 24, wherein said cart is on wheels,rollers or casters.
 31. The method of claim 24, wherein said containersare secured until required data is entered into said data processor. 32.The method of claim 24, wherein said containers automatically open uponentry of required data in said data processor.
 33. The method of claim24, wherein one of said containers automatically opens upon entry ofrequired data in said data processor.
 34. The method of claim 24,wherein said containers are drawers or latched receptacles.
 35. Themethod of claim 34, wherein said containers comprise drawers containinglatched receptacles.
 36. The method of claim 24, wherein said containerscontain unit dose packages of drugs.
 37. The method of claim 24, whereinsaid containers contain only one type of anesthesiology item percontainer.
 38. A system comprising: a health care facility computernetwork; and a mobile cart including a data processor on said cart, saidcart adapted to be supplied with anesthesiology items in containers onsaid cart, at said health care facility, said data processor adapted tobe connected to said computer network and adapted to be disconnectedfrom said computer network when said cart is moved to an area whereanesthesiology items are administered, said data processor adapted forentry of data regarding anesthesiology items removed from saidcontainers even while said data processor is not connected to saidcomputer network, said data transferred to said computer network whensaid data processor is connected to said computer network.
 39. Thesystem of claim 38, further comprising: a touchscreen data entry videoterminal on said cart and connected to said data processor. items inordered fashion and the contents of each container is input into acomputer memory prior to said anesthesiology items being administered.40. The system of claim 38, further comprising: a security device inassociation with at least some of said containers on said cart toprohibit access to said at least some of said containers prior to entryof required data in said data processor.
 41. The system of claim 38,wherein each of said containers are loaded with anesthesiology items inan ordered fashion and the contents of each container is input into acomputer memory prior to said anesthesiology items being administered.42. The system of claim 41, wherein said computer memory is in saidcomputer network.
 43. The system of claim 41, wherein said computermemory is in said data processor.
 44. The system of claim 40, whereinsaid security device is an electronically operable lock in communicationwith said data processor.
 45. The system of claim 38, wherein said dataprocessor is adapted to perform inventory control functions.